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Malignant Otitis Externa: A persistent challenge
Mayssa Khribi1, Wed El Abed1, Khalil Gnaba1
1ENT Department - Ibn El Jazzar Teaching Hospital of Kairouan, Tunisia. Medical University of Sousse.
Introduction:
Although rare, Malignant otitis externa is responsible for a high morbidity and could sometimes be fatal. The management of this condition is still challenging.
Aim:
To analyse the clinical, microbiological and radiological profile of malignant otitis externa, and the management of this condition.
Methods:
A descriptive, cross-sectional study was conducted at ENT Department of Kairouan's hospital including 38 patients hospitalised and treated for malignant otitis externa from January 2013 to August 2021.
Results:
The mean age of patients was 67.7 ± 12.9 years (35-98). All patients presented with continuous otalgia that resists to usual analgesics. Otorrhea was noticed in 76.3% of cases, facial palsy in 2 cases (5.3%) and dysphonia in one case (2.6%). Pseudomonas Aeruginosa was the main responsible pathogen (42%). Concomitant bacterial and fungal infection was noticed in 6.4% of the cases. First-line intravenous antibiotherapy used was mainly based on an association of Cephalosporins and Fluoroquinolones. Complete remission was noticed in 30 patients (79%). However, 8 cases of recurrences (21%) and 2 cases of deaths (5.2%) were noticed in our series. The mean follow-up was 4.6±6.3 (1-26 months).
Conclusions:
Pseudomonas Aeruginosa remains the main responsible pathogen for malignant otitis externa. Nevertheless, fungal infections are rising because of the overuse of antibiotics. Antibiotherapy should be adapted to culture results and resistance profile of pathogens in hospital. Practionners should be aware of the possibility of concomitant fungal infection, especially in the case of unfavorable evolution.
Insights
Malignant otitis externa, a serious condition, is often caused by Pseudomonas Aeruginosa. Fungal infections are increasing, necessitating tailored antibiotic therapy based on culture results and pathogen resistance profiles.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Medical Microbiology
Background:
- Malignant otitis externa (MOE) is a rare but severe infection with high morbidity and potential fatality.
- Management of MOE remains a clinical challenge, requiring comprehensive understanding of its characteristics.
Purpose of the Study:
- To analyze the clinical, microbiological, and radiological features of MOE.
- To evaluate the management strategies and outcomes for MOE patients.
Main Methods:
- A descriptive, cross-sectional study was conducted.
- Included 38 patients hospitalized for MOE between January 2013 and August 2021.
- Data collected on clinical presentation, microbiology, treatment, and outcomes.
Main Results:
- The average patient age was 67.7 years; common symptoms included persistent otalgia and otorrhea.
- Pseudomonas Aeruginosa was the primary pathogen (42%), with a noted increase in fungal co-infections (6.4%).
- Complete remission was achieved in 79% of patients, but recurrence (21%) and mortality (5.2%) were observed.
Conclusions:
- Pseudomonas Aeruginosa is the predominant pathogen in MOE, but rising fungal infections warrant attention.
- Antibiotic therapy must be guided by culture results and pathogen resistance patterns.
- Clinicians should consider fungal co-infections, especially in cases with poor prognosis.
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